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Israel: Government Blocks Medical Evacuations from Gaza

Denials, Delays Cause at Least Three Deaths

(New York, October 20, 2007) – Israel is arbitrarily blocking, delaying and harassing people with emergency medical problems who need to leave the Gaza Strip for urgent care, Human Rights Watch said today. At least three patients denied exit permits have died since June, and others have lost limbs or sight due to injuries and disease that have gone without proper treatment.  

" Israel is punishing sick civilians as a way to hurt Hamas, and that’s legally and morally wrong. Israel remains the occupying power in Gaza despite disengagement, and thus has a legal obligation to facilitate medical care to the greatest extent possible. "
Sarah Leah Whitson, director of Human Rights Watch’s Middle East division

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Despite its 2005 disengagement, Israel maintains substantial control of Gaza’s borders – land, air and sea. Since June 2007, when Hamas forcibly seized power in Gaza, Israel has made it increasingly difficult for medical supplies to get into Gaza and for any of Gaza’s 1.4 million residents to get out, even when they urgently need medical treatment.  
“Israel is punishing sick civilians as a way to hurt Hamas, and that’s legally and morally wrong,” said Sarah Leah Whitson, director of Human Rights Watch’s Middle East division. “Israel remains the occupying power in Gaza despite disengagement, and thus has a legal obligation to facilitate medical care to the greatest extent possible.”  
The Israeli government, and in particular the General Security Service (Shabak), cite unspecified “security concerns” when denying medical patients exit permits from Gaza. But numerous examples point to the arbitrary nature of those decisions, Human Rights Watch said.  
This week, for example, the Israeli government allowed six people with life-threatening conditions to leave Gaza, after the Tel Aviv-based Physicians for Human Rights-Israel (PHR-Israel) threatened to challenge the denied permits in court. The government had previously rejected all six on two separate occasions, citing unspecified security concerns.  
The six cases include a 16-year-old girl with a congenital heart defect and two women in their twenties with cancer. They all have conditions that Israeli doctors determined require treatment outside Gaza, and one of the women had previously received chemotherapy in Israel.  
Since June, PHR-Israel has intervened in 138 cases of patients from Gaza whom the government had rejected for alleged security reasons. It succeeded to date in gaining exit permits for 52 of these people.  
According to PHR-Israel, in some cases the person was allowed out of Gaza only if he or she submitted to interrogation by the Shabak. An article this month in the major Israeli daily newspaper Ma’ariv documented how intelligence officers at Erez crossing, the only passenger crossing in and out of Gaza, tell medical patients that they can leave only if they provide information to Israeli intelligence.  
A father who recently accompanied his five-year-old son out of Gaza to receive care for an injured eye told Human Rights Watch how he underwent questioning by Shabak at the border in a concrete room with a floor of metal grating that looked down onto an exposed basement. Interrogators sat behind bulletproof glass. Other Palestinians who left for non-medical reasons described the same room.  
Israel is taking these measures at a time when its strict control of what gets into Gaza has led to deteriorating medical conditions there, Human Rights Watch said. According to the World Health Organization (WHO), the increasing restrictions are “putting the access to health care especially in regard to tertiary care at risk.” The organization cites a lack of some oncology drugs and a shortage of functioning laboratory equipment.  
Medical facilities in Gaza cannot provide many advanced services, such as cardiovascular surgery, neurosurgery and advanced ophthalmology services.  
“There are no machines to treat this in Gaza,” said the father of the 16-year-old girl with the heart defect, who was finally allowed to cross into Israel this week. “If it was possible we would have done it here months ago.”  
In a visit to the dialysis ward at Gaza City’s al-Shifa Hospital, this week, Human Rights Watch found doctors having to use catheters whose expiry date had passed. “We sterilize them and do our best,” a doctor said.  
Human Rights Watch expressed concern that Israeli restrictions on the transfer of individuals and goods in and out of Gaza, including medical supplies – aimed at putting pressure on Hamas – are a form of collective punishment against the civilian population in violation of international humanitarian law.  
In September, the Israeli cabinet declared Gaza “hostile territory” and voted to restrict “the passage of people to and from Gaza.” The government says implementation of the decision is pending legal review, but the flow of people and goods into and out of Gaza has steadily declined since the cabinet’s decision, according to numbers provided by the Israeli military.  
According to the United Nations, an average of 40 patients per day entered Israel from Gaza for medical treatment in July. In September, that number was down to five.  
“Israel’s denial of medical care to those in urgent need amounts to collective punishment against the population, which violates international law,” Whitson said. “The civilians of Gaza are paying the price.”  
In June, PHR-Israel and another Israel-based human rights group, Gisha, challenged Israel’s restrictions on medical evacuees in the Israeli Supreme Court. The court rejected the petition and accepted the government’s distinction between life-threatening cases, which should be allowed out of Gaza on a humanitarian basis, and those that affect “quality of life,” for which the state can exercise discretion. But that distinction, when followed at all by the government, has been applied inhumanely.  
According to PHR-Israel, in June the Israeli government denied an exit permit to `Ala’ `Awda, 25, who needed emergency treatment after getting shot in both legs, because it did not consider his case life-threatening. `Awda was unable to get proper care in Gaza, and doctors had to amputate his right leg. The government denied a second request, deeming the one-legged `Awda a security threat, and shortly thereafter doctors amputated his other leg.  
At least three patients who were rejected for security reasons since June have died. According to PHR-Israel, they are:  
  • Muhammad Murtaja, 19, who died from a malignant brain tumor on the morning of July 1. The government approved his second request for entry later that day.  
  • Na’il Abu Warda, 24, who suffered from chronic renal disease. He had permission to leave Gaza but was denied transit through Erez nevertheless and died that night.  
  • Muhammad Abu `Ubaid, 72, who died on October 3 in need of open heart surgery after his exit permit was denied.  
This week, Human Rights Watch interviewed three people in Gaza with medical conditions who were prevented from leaving on security grounds. They included a man who said he was accidentally shot in the ankle in May, who was not allowed out despite getting an exit permit, the girl with the congenital heart defect, and a woman with Hodgkin’s lymphoma. The latter two were among those allowed out this week.  
Human Rights Watch interviewed three other people who were applying for their exit permits, including a man with a herniated disc, a man with nerve compression in his back, and a man with thyroid cancer. “I will go to any country, I don’t care,” said `Abd al-Safuri, 27, who needs surgery for a herniated disc.  
With some exceptions, patients allowed out of Gaza must walk nearly 1 kilometer through a security zone to reach the Erez crossing, and then submit to extensive security procedures and occasional interrogation by the Shabak.  
Human Rights Watch learned of some patients with prearranged clearance at Erez, who were nonetheless sent back, again for unspecified security concerns. They had to restart the complex process of getting a bed in a hospital outside Gaza, secure financial coverage, and seek security clearance for another day.  
“Israel has legitimate security concerns about militant groups firing rockets from Gaza into civilian areas,” Whitson said. “But denying medical treatment to a 16-year-old girl with a congenital heart defect doesn’t make Israel any safer.”

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